HIV resistance testing in the USA--a model for the application of pharmacogenomics in the clinical setting.

Although there is debate about how and when the medical community will readily adopt pharmacogenomics into clinical practice, HIV genotyping has become an integral part of AIDS patient management in the USA since 1996. Genotyping for HIV-1 drug resistance serves as a paradigm for the way pharmacogenomics is likely to be introduced into patient care. This review discusses the unique role that HIV-1 genotype testing plays in identifying resistance in patients and how that information is used to modify therapy selection and impact the progression of disease. In addition, the important issues relating to reimbursement and the cost-effectiveness of genotyping are also discussed.